FALLS IN THE ELDERLY

Risk Factors:

1. Dementia – all types. Especially consider normal pressure hydrocephalus triad of gait disorder, incontinence and dementia, as is potentially treatable.

2. Myelopathy including spondylosis and B12 deficiency. Look for peripheral hyperreflexia.

3. Peripheral neuropathy

4. Visual impairment

5. Drugs

· Alcohol

· Benzodiazepines

· Antidepressants

· Neuroleptics

· Narcotics unlikely to cause falls

6. Parkinson disease

7. Increasing number of chronic diseases

8. Lower extremity chronic pain or reduced mobility

9. History of previous falls

10. Cardiac arrhythmias or hypotension

11. Seizure disorder

Investigations:

1. Head CT if

· Neurologic signs

· Dementia early onset or rapid progression

· New headache or seizures

· Urinary incontinence, dementia and gait disturbance

2. ECG or Holter where appropriate

3. Carotid doppler where appropriate

4. Drug levels and toxicology

5. B12 and folate

6. VDRL, HIV, ammonia and liver enzymes, creatinine where appropriate

Prevention and harm reduction:

1. Supplemental Vitamin D prevents falls as well as increasing bone density

2. Regular exercise, coordination and balance training.

3. Home hazard modification

4. Aids such as canes, walkers

5. Hip protectors

6. Floor modification to wood and carpet where possible

7. Optimization of bone density with diet, exercise, optimum calcium, Vitamin D and bisphosphanates if necessary

8. Ongoing mental stimulation to minimize progress of dementia

References:

1. Overview of falls in the elderly. Up to Date online version 12.3. Accessed Jan 2, 2004.

2. Simpson A. et al. Does the type of flooring affect the risk of hip fracture? Age and Ageing 2004 33:242-246

3. Bischoff-Ferrari, H.A et al. Effect of Vitamin D on falls: a meta-analysis. JAMA 2004 Apr 28; 291(16):1999-2006